Emergency Ultrasound Directors have keen insights into running safe and efficient point-of-care ultrasound (POCUS) programs in the ED. As POCUS has grown into many specialties throughout the past two decades, there is a need for standardization and leadership within hospital systems. System-wide or institutional point-of-care ultrasound initiatives are highly complex involving most clinical departments, hospital leadership, credentialing committees, purchasing, revenue management, and multiple technical teams. Strategies to propose, negotiate, lead, and maintain a multidisciplinary POCUS program are discussed in detail.